Why conscious sedation?
In the newborn period, tongue tie division is a quick, simple procedure. As infants grow past 12 weeks of age, they become increasingly aware, stronger, and aftercare is more difficult. Performing a frenuloplasty means the diamond-shaped site is closed with absorbable sututres to facilitate healing.
As children grow older, the challenge changes. A toddler or older child cannot cooperate with a procedure in the mouth and in many cases will have been told that general anaesthesia is the only option. Conscious sedation changes that.
Conscious sedation allows the procedure to be completed thoroughly, safely, and without distress to the child. The child is sedated but breathing independently, monitored throughout by Dr. Roche and our clinical team, and recovers quickly.
What is the difference between conscious sedation and general anaesthesia?
Conscious sedation is a medically controlled state of reduced consciousness in which the child is relaxed and comfortable but continues to breathe independently and can be roused. It is substantially different from general anaesthesia. Recovery is rapid, the child can eat and drink within a short time after the procedure, and the risks associated with general anaesthesia in children are avoided. The procedure is conducted under full monitoring by Dr. Justin Roche and our team.
Infants aged 12 weeks to approximately 6 months
Who is this service for?
- A tongue tie assessment or division was not possible in the newborn period
- An initial procedure was incomplete and revision is needed in an older infant
- Restriction was identified late and the infant is now past the age for division without sedation
- Another provider has said the baby is too old for treatment or must wait
- A previous division has reattached and the infant is now over 12 weeks
Children aged 6 months to 12 years
For children aged six months to 12 years, conscious sedation frenuloplasty is the alternative to general anaesthesia. Where families have been told that surgical treatment of tongue tie in their child requires a general anaesthetic, this service provides a different option: the same procedure, performed to the same standard, without the risks and recovery associated with general anaesthesia.
Conscious sedation carries a substantially different risk profile from general anaesthesia. The child breathes independently throughout, recovery is rapid, and the child can eat and drink within a short time after the procedure.
There is also a clinical advantage specific to conscious sedation that is worth understanding. When a child is sedated rather than fully anaesthetised, the natural tone of the tongue musculature is preserved. It is this tension and resistance in the tissue that allows Dr. Roche to identify precisely where the fascial restriction lies during the procedure. That precision directly affects the thoroughness and efficacy of the release. Under general anaesthesia, muscular tone is lost, and with it some of the clinical information that guides the surgeon.
Many families also find it a relief that their child will be unaware of the procedure as it happens. There is no need to manage anxiety on the day, and no experience for the child to process or remember afterwards.
Who this service is for
Children come to us through a number of routes. Some had a tongue tie identified in infancy that was not treated, or was treated incompletely, and are now presenting with speech difficulties, fussy eating, mouth breathing, dental crowding, or disrupted sleep. Others have been assessed by a speech and language therapist who has recommended release, but the options available locally are limited. Some families have been told that the only pathway forward is general anaesthesia and are looking for an alternative. Others have had a previous division that reattached or was functionally inadequate, and revision is now needed.
If any of these situations apply to your child, this service was designed for exactly that.
Pre-procedure preparation and post-procedure support
We prepare families thoroughly before the procedure: pre-operative feeding and oral motor support, bodywork to address jaw and neck tension that may affect the outcome, and a clear explanation of exactly what the sedation involves and what to expect on the day.
Post-procedure, we provide structured rehabilitation and wound care guidance, and our team is available for follow-up support throughout recovery. For older children, this rehabilitation includes myofunctional exercises and feeding therapy that the child can actively participate in. Our approach, Release Restrictions, Retrain Function, Relieve Tension, is as important here as in any other age group.
The National Tongue Tie Centre was established in 2010 as Ireland's first clinic dedicated entirely to the assessment and treatment of tongue tie. The centre treats over 1,000 patients per year and receives patients from across Ireland and internationally.
Led by Dr. Justin Roche (Consultant Paediatrician, FRCPCH, FRCPI, IBCLC), Kate Roche (Chartered Physiotherapist, IBCLC, Feeding Therapist). Clinics in Clonmel, Co. Tipperary and Kildare.
Frequently asked questions
Conscious sedation in this age group, administered by an experienced Consultant Paediatrician with appropriate monitoring, carries a very low risk profile. Dr. Justin Roche has an extensive background in paediatric medicine and has developed this protocol specifically for this indication. We can discuss any concerns you may have in full at your assessment appointment.
We will discuss the specific sedation protocol with you fully at your consultation. The medications used are well-established in paediatric practice and the sedation is titrated carefully to achieve the appropriate level of relaxation while maintaining independent breathing. Side effects are uncommon and typically mild and short-lived. Dr. Roche will answer all your questions in detail.
Yes. Feeding can resume shortly after the procedure once the infant is fully alert and the clinical team are satisfied with recovery. Our IBCLCs are available on the day to support the first feed post-procedure and advise on the transition home.
No. Older infant frenuloplasty under conscious sedation allows thorough treatment of restrictions that may not be safely manageable in an unsedated infant of this age. The tongue tie is not too thick nor baby too old to treat; it requires the appropriate approach, which is precisely what this service provides.
The conscious sedation service is provided at our Clonmel, Co. Tipperary clinic, where we have the full clinical infrastructure to support the procedure safely. Consultations and standard infant assessments can be arranged at both our Clonmel and Kildare locations.
Yes. Revision frenuloplasty under conscious sedation is one of the most common indications for this service. If your baby had a previous division that reattached or was incomplete and they are now older than 12 weeks, this service is specifically designed for that situation.
Yes. Conscious sedation in this age group, administered by an experienced Consultant Paediatrician with appropriate monitoring, carries a well-established safety profile. Dr. Justin Roche has an extensive background in paediatric medicine and adapts the protocol to the age and weight of each child. Any specific concerns you have will be discussed fully at your assessment appointment.
For most children in this age group, yes. Conscious sedation and general anaesthesia are substantially different: under conscious sedation the child breathes independently, recovery is rapid, and the risks associated with general anaesthesia in children are avoided. There is also a clinical advantage in that normal muscle tone is maintained during the procedure, which aids precision. Whether conscious sedation is appropriate for your child specifically will be confirmed at assessment.
Your child will be sedated and will not be aware of the procedure while it is taking place. In the lead-up, we advise keeping the explanation simple and age-appropriate: they are coming to see the doctor, they will have some medicine that makes them sleepy, and they will wake up when it is finished. Our team will guide you on what to say and how to prepare your child in the days before, including fasting requirements and what to bring on the day.
It is very common, and it is one of the reasons conscious sedation is appropriate for this age group. Because your child will not be awake during the procedure, pre-procedural anxiety does not affect what happens in the room. Our team is experienced in working with anxious children and their families, and we take time to make sure everyone is prepared and comfortable before the day.
Yes. Revision frenuloplasty under conscious sedation is a common indication for this service in older children. Reattachment, incomplete initial release, and procedures carried out without adequate post-procedure rehabilitation are all situations we see regularly. A full assessment will establish what has happened and what is needed.
Children recover quickly from conscious sedation and are alert within a short time after the procedure. In terms of returning to school, this depends on the individual child and the day of the week the procedure takes place, but many families plan for one day at home and return the following day. We will give you specific guidance at your pre-procedure appointment.
Yes, always. We do not perform procedures without a thorough evaluation at the National Tongue Tie Centre first. That assessment establishes the nature of the restriction, whether surgical release is clinically indicated, and what preparation and rehabilitation will be needed. You are welcome to bring any existing reports from your speech therapist and we will take these into account.
Book a comprehensive assessment at the National Tongue Tie Centre. If your child is between 12 weeks and 12 years and has not been treated, has had an incomplete release, or has reattached, contact us to discuss whether conscious sedation frenuloplasty is the right step. Conscious sedation procedures at our Clonmel, Co. Tipperary clinic.
Frenuloplasty is a surgical procedure. Risks, benefits, and individual expectations will be discussed in full at your assessment appointment before any decision to proceed is made.